InterAct Event Registration Form

    Event Description

    Date of Event

    Time of Event

    Event Location - Street Address


    Zip Code

    Purpose of Event
    Community Engagement and OutreachDonation DriveFundraising

    Event Frequency
    One TimeMonthlyQuarterlyIndefinite

    Event Website

    Event Facebook

    Event Twitter

    Contact Telephone

    Use of InterAct Logo?

    How Will Logo Be Used?

    Request for InterAct Materials
    InterAct MaterialsDomestic Violence MaterialsSexual Assault Materials
    Additional Materials (please list)

    Are You Reuqesting An InterAct Booth At Event?

    Are You Requesting A Representative from InterAct At Event?

    Time Speaker Needed

    I have read and understood the above guidelines and registration and ensure InterAct's name will be properly used, funds will be handled and accounted for in a responsible manner, fundraising will be conducted in a method that is consistent with the public image of InterAct and that all those associated with the event or promotion will act in accordance with all municipal and federal laws. I understand that at anytime InterAct can withdraw its permission if it feels its reputation is at risk or any other liability or challenge arises.